At the age of 100+ years, I have had long experience both of practice (as Professor of Paediatrics in Manchester and Cambridge) and as a patient (which I still am). I venture to suggest in your columns my view of how the Health Service might best be reorganised by whichever party wins the coming election based on recognition that medicine is a profession (and as such mistaken in using the strike as a way of determining its emoluments both because of our public commitments and because, not being a competitive industry, it can only be effective by blackmailing the general public) and therefore with its own ethical standards and trustworthiness.
The present imbalance between hospital and domiciliary practice is in my view due to the emphasis on medical education in diagnosis, treatment and saving the lives of sick patients at the expense of prevention and the maintenance of rude health. As I have seen/experienced it, medical practice exhibits three forms -- ie, the consultation at which a person’s concern about the well being of themselves or of persons for whom they are responsible is discussed, emergencies, and care, usually in hospital when their illness demands it. Ideally, in my view, their provision should be a local responsibility but with agreed access to specialised hospitals at provincial or national level.
Locally a population should be served and paid for by one or more medical practices, a cottage hospital and a MOH working in concert and staffed by appropriately educated physicians, surgeons, nurses and ancillary workers such as ambulance drivers, ward orderlies, porters, etc, with GPs taking turns in dealing with hospital referrals and instructing medical students prior to their choosing whatever specialities appeal to them -- ie ,whatever combination of science and humanity. As I see it, once a student has completed his/her study of anatomy, physiology and psychology, they should join a general practice as assistants and qualify as ‘doctors’ when sufficiently experienced – subsequent education being in their chosen speciality whether in hospital or what would be termed social practice in epidemiology or pathophysiology which are the two sciences underlying illness. The science of epidemiology is of course the province of medical officers of health and the ministry of health whereas pathophysiology is the province of the academy of medical sciences and the ethics of practice to the Royal Colleges to whose tally I would add a Royal College of Reproduction comprising obstetrics and neonatal paediatrics.
What I have failed to deal with in the above essay is convalescence, which should become the responsibility of a third branch of medicine -- ie the care of persons who are neither ill nor well and based on adequately staffed soi-disant ‘homes’ or their own and would include those who are very old, those with disabilities, and those with dementia who can’t cope on their own when discharged from hospital. Should the carers be relatives – parents, siblings, wives or husbands, etc -- they should be paid the same as unrelated staff for the same services and be subject to the same discipline and oversight. Just as the Tudor monarchies and in particular Queen Elizabeth I took over from the monasteries the care of those elements of the population unable to manage their own independent lives, so the modern welfare state should accept the burden as equivalent to that accepted by the parents of children before they grow up including the supervision of their conduct should it fall below acceptable standards.
Yours faithfully
John A Davis
Competing interests:
No competing interests
11 July 2024
John Davis
Retired Professor of Peadeatrics at University of Cambridge
Rapid Response:
Re: Conservative Party’s legacy on the NHS
Dear Editor
At the age of 100+ years, I have had long experience both of practice (as Professor of Paediatrics in Manchester and Cambridge) and as a patient (which I still am). I venture to suggest in your columns my view of how the Health Service might best be reorganised by whichever party wins the coming election based on recognition that medicine is a profession (and as such mistaken in using the strike as a way of determining its emoluments both because of our public commitments and because, not being a competitive industry, it can only be effective by blackmailing the general public) and therefore with its own ethical standards and trustworthiness.
The present imbalance between hospital and domiciliary practice is in my view due to the emphasis on medical education in diagnosis, treatment and saving the lives of sick patients at the expense of prevention and the maintenance of rude health. As I have seen/experienced it, medical practice exhibits three forms -- ie, the consultation at which a person’s concern about the well being of themselves or of persons for whom they are responsible is discussed, emergencies, and care, usually in hospital when their illness demands it. Ideally, in my view, their provision should be a local responsibility but with agreed access to specialised hospitals at provincial or national level.
Locally a population should be served and paid for by one or more medical practices, a cottage hospital and a MOH working in concert and staffed by appropriately educated physicians, surgeons, nurses and ancillary workers such as ambulance drivers, ward orderlies, porters, etc, with GPs taking turns in dealing with hospital referrals and instructing medical students prior to their choosing whatever specialities appeal to them -- ie ,whatever combination of science and humanity. As I see it, once a student has completed his/her study of anatomy, physiology and psychology, they should join a general practice as assistants and qualify as ‘doctors’ when sufficiently experienced – subsequent education being in their chosen speciality whether in hospital or what would be termed social practice in epidemiology or pathophysiology which are the two sciences underlying illness. The science of epidemiology is of course the province of medical officers of health and the ministry of health whereas pathophysiology is the province of the academy of medical sciences and the ethics of practice to the Royal Colleges to whose tally I would add a Royal College of Reproduction comprising obstetrics and neonatal paediatrics.
What I have failed to deal with in the above essay is convalescence, which should become the responsibility of a third branch of medicine -- ie the care of persons who are neither ill nor well and based on adequately staffed soi-disant ‘homes’ or their own and would include those who are very old, those with disabilities, and those with dementia who can’t cope on their own when discharged from hospital. Should the carers be relatives – parents, siblings, wives or husbands, etc -- they should be paid the same as unrelated staff for the same services and be subject to the same discipline and oversight. Just as the Tudor monarchies and in particular Queen Elizabeth I took over from the monasteries the care of those elements of the population unable to manage their own independent lives, so the modern welfare state should accept the burden as equivalent to that accepted by the parents of children before they grow up including the supervision of their conduct should it fall below acceptable standards.
Yours faithfully
John A Davis
Competing interests: No competing interests